Uremic encephalopathy Quiz: Ace Your Exams

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A 67-year-old man presents to the emergency department for evaluation of progressive confusion. The patient's partner states the patient has a history of chronic kidney disease (CKD) and has missed multiple dialysis sessions due to issues with transportation. Additional past medical history includes alcohol use disorder, hypertension, diabetes, and hyperlipidemia. Temperature is 37.2°C (99°F), blood pressure is 185/95 mmHg, pulse is 98/min, respiratory rate is 18/min, and O2 saturation is 94% on room air. Physical examination reveals a sleeping patient who is arousable to painful stimuli only. The patient has poor attention and confused speech. He is moving all extremities spontaneously. A thrill is palpable over a left upper extremity fistula. An image of the patient’s scalp is shown below. ECG demonstrates normal sinus rhythm and peaked T waves. Which of the following metabolic derangements is most likely the cause of this patient’s condition?  


Reproduced from: Wikipedia 

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